TRANSMTTTAL of OMAHA LEAD STTE 

SOIL REMEDLVTION FILE FOLDER 

SAn)#: iFllff^^ Date: otlir ) ;3olO 

Address: ,|Ul g CorU ) ^ V 

RemediationContiactor: IjVuAtiy^^ "Ullv \v\fl. Year: (^0\ 0 

SOIL REMEDL^TIO N 

PROPERT Y FIL E FOLDE R DOCUMENT S 

0 Video of property (DVD) 

2I Executive Summary 

E EPA-provided property sketch 

BJ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adja^«nt property 

ii^ Restoration Agreement 

D Settlement documents (i.e., for dami^ e or to replace plants, etc.) 

BJ Confirmation data 

Of Photograpihs 

a As-built sketch 

3 Satisfectory restoration signed b y Property Owne r 

ffl Property close-out check list signed by EP A 

D Description of areas not meeting ROD cleaniq) criteria 

Q Utility clearances 

Ql Property information from Douglas County Assessor's Office 

D 

D 

n 

fetignatirte Date 

30054191 

• ii 

Superfund 
Rnd Record 

Backfill: 

Sample Area: 29693 -161 8 CORBY ST 

Owner: 

n Owner Occupied 

Owner Name: 

CTTY OF OMAHA 

Owner Addressl: 

C/0 JAMES THELE 

Owner AddressZ: 

1819 FARNAM ST #1111 

aty: State: Zip Code: 

OMAHA |NE |68183 

Owner Phone: AKemate Phone: 

Remediation Query I Lead Remaining Query I Property Damage Query 

Resident: 

Resident Name: 

Property Address: 

|1618 CORBY ST 

Zip Code: 

|68110 

Resident Phone 

I 

Contract: 

Contractor: 

|PRUDEi^T2009_S 

Contract Option 

OPTION 3 

Assessment: 

Qualifying Group 

400 

Assessment Max XRF Value: 

I 42^ 
PROPERTY SUMMARY 

Date;0l/15/2010 | Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l | Month of: ^(^, f 

Property Address; 1618 CORBY ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Fl = 51 PPM @ 10"; EA = 200 PPM @ SCRAPE (-1") 

ATTACHMENTS 

1) Property sketch provided by EPA pursuant to contract specifications 

2) Signed Access Agreement including access agreements required for crossing other properties 

3) Pre-Excavation digital video clip/photographs 

4) Post-Excavation digital video clip/photographs 

5) Documentation - Completed Close-out Checklist 

6) As-Built sketch ­

i) Shall include final lead levels v) Legend 

ii) Contamination left behind areas vi) Contractor identification 

iii) Property address vii) Date 

iv) BVID number 

7) Other items to be included in the individual property file, if available, or obtained include: 

i) Pre-excavation agreement details (if any are made with the property owner) 

ii) Property Status Form signed by property owner 

iii) Excavation digital video in MPEG, WMV (Windows Media Video) or SWF (Flash Player) format and/or 

photographs 

iv) Signed form verifying satisfectory restoration 

v) Description of areas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES, INC. 
•ITECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: <39(p93 Property Address: \{ji\^ Coxbvj 5 ^ 

Date/Time: la||/o 9 Owner's Name: ^/K* , aS- a w^-^A.*^ 

Quads Excavated: Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

1. If necessary, were tlie correct quadrant(s) excavated and restored? y 

2. If necessary, were the correct areas of drip zone excavated and restored? • 

Grading Sod and Vegetation 

1. Does the grading arouiid the perimeter of the house in excavated areas generally slope away 

from the house? 

Yes

• 

 No 

2. 

3. 

Has sod been laid in all areas that were excavated? 

Does tlie sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day time period) 

y 

y 

4. 

5. 

Are sodded areas generally firm and evenly graded? 

Are die joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) 

y 

y 

6. Was die property graded such tliat water will not pool on the property? y 

7. Was damage to landscaping or plant materials avoided? 

y 

Gates, 

1. 

Fences and Retaining Walls 

Do gates open and close freely? (If applicable) 

Yes

y 

 No 

2. Were all gates or fences taken down during restoration activities reinstalled? (If applicable) y 

.1. Was damage to gates or fences avoided? (If applicable) y 

4. Was damage to retaining walls avoided? (If applicable) y 

Foundation, Siding and Gutters 

1. 

2. 

Was damage to the siding or trim avoided? 

Was damage to tlie foundation avoided? 

Yes

y 

y 

 No 

.3. Was damage lo windows avoided? y 

4. Was damage to windows or door screens avoided? y 

5. Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) Yes No 

1. Was daiuiige to driveway surfaces avoided? y 

2. Was damage to walkway surfaces avoided? 
Owners comments: 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranty: 

EPA Representative dour i ^ , Date: /z/jt/of 
No. 7050 P. 2«"/ooo 3 

^ov.25. 2009 10:17AM OM/|^PLANNING DEPT. 402-444-6140 

Property Completion Agreement 

This {igrtemenl documents the completion of removal activities performed on the below listed property. 

The property owner's sigiiaturc indicates tliat the properly owner is satisfied with the restoration of die 

subject i:roperi:y, and tiiac no items arc in. question, now, or at any time in the flilurc, cKcIudiiig any 

remaiiiini warranty (30 days total) except those items listed below, if any. 

«<T3>UtafMnt.»M»vAnU«hH«ri— 

5 Propert)- ID 

I Property Addretis 

''^.^Mtl^.^Cs>rhy ^ , ^ } Owner: !J^/lAl.>g5l?.—J^giE?ria<ab: 

Phone: 

y; 

^ 

Restorat'on Items in Question: 

Item: 

Item: 

Item: 

i

lt«m: 

Item: 

Item: 

J 

Requires corrections to complete the property: 

fesa.-.-^y'.-.. 

agree restoration is completed, 

n I do lot agree restoration is completed at i(notec| deficiencies above) 

^ S''/.~//u^,^ysr^(^-Oy 

Dace 
No 

4421 P. \Q2^^oQi 

OM ^ PLANNING DEPT. 402-444-614 0 

looct . 9. 2009*10:12AM 

iVfL'.WiVudciH Tsclinoloftiw. inc. (PnnJonl) n under conliocl Willi the U. S: Environmcnml ProWclion AftWcy c,KI'A) lo clCiin up leud 

^jO)l/T»iu number orortpirtiMloaicd ill Oowhs.Ncbcwkii.uidudmg tht property )<t«ile«l 81 

T ^ •••'•• v»- ' • TlicEPATQi]U«sl$yourpemutsion wallftwPmdeni to pwform « noil clcsmipnl d»is 

prsp&lv lo remove iSi^SwwwfcSl . By nignins iW» roiw, lhe ptoptrty ownorfirooW )wnn.«»ww n> Pwdciil lo pcrfom 

(igdviiics rv;l.-.irtl I" il)i: clciiinip including svil inmplinB, mmovsl of lia<l-conwmin»l«l wil and ix.->uwiiffli «r ihc rctcrcncctl proiwiy. 

irY«uUwvcmiyqiwsiionsabi>uiO»c.wilcl8«n«ippliinJiedfwjrpur property, p1eosi3<i«\liiciPnKlc»i'* lor (lie 

OiMhaI,«:.dSui:do-.im.p. , 01(402) ..^ General V)UMU6r»abouUbeOra«hi»U»d .Sittclcam-pcpntx: 

UitwlEd !o m« KPA ftiblic mrorTHalioii CflPlereiH («02) 7J1 -3045 (Sowh 0.«»ba office) w {4(I2> <)•; l-95S:{ (Norrh fJrrsaha officcl. 

WopcHv Accc.« G^nlcd Oy: )( <^/- ^ ^1 ^ g)^/«^- ^ 

~r / fT^ ^ (Plwjj; Print NsTOcl 

l*rop«rty (Cteiiil 

!• ; PROFERTT INFORMATION 

fro be couipMcit t y reiidcbt anit/or propcrtv owner - piQ«sv print) 

RESIDEN V/4- Renter T NAME: 

KESID£NT AODR/ESS: 

IF RENTAL, PRopERTY OWNED BYl 

_x> 

•WNER'S MAILING ADDRESS: ^_ ^ y ^ n 

OWNER'S TELEPHONE NUMBER - HOME:- ^\'., ] 

X ASe OF HOME??: A/;> : ^ YiiARS- HOW LONG HAVE YOU LIVED HERE? YEARS. 

j . ; 

„Ye S NO A/4 - / ( ^* ^ ^" ^ EXTERIOR BEEN PAINTED OR COVERED WITH SIDINq SINCE 1974? 

IA/LA . DUMBE R O F OCCUPANTS UNDER 7 YEAfti OLD: __^ NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

fjj ^ )(^NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK; 

y COMMENTS OR SF'ECIAL INSTRUCTIONS: (I.E. DOOS, ENTRY OATES, ETC.! 

Aimic>RJ'rV FOR I.VNVIRI,1NM»-:NTAI. KKSIHrNacACUONS; llw«cliviiios 10 be implewwied by fil>Aundatihi«my«omciu 

Div iHiisiKiiH Ul SwiMiii KM ii!'Ci:RCi.,A, a U.."5.C. %\>i. \i?,\'t i-ijjl)ior wiwjix lo Uiu iiropcrly n pnavulcJ for m HaiMyin I<,M<c) of 

d.'l^fL.'S. t J 11 S C o^-O^tvi). whwU pmvirfe* oiitTv ffPT •'dtiqrfpinir? iho neod for rwponnc. Or chnosinc m lalcmii qnv n;.iiHinTO anUim 

uiiuVr* Uiw Wc, or mlicnvifc enCiYTclnii tjw. provision* ol'lhclitlc.'" 

••{080 V«.lrfl f*.-.rkv7.!v. .>fi ..Jvv- A-. .''• i-Siccj:. ii-.;!'.'.; 'iW .It-Vi W(.y.l'.<;<ii Orivt. S'.ir* 4-iSO ^.•^nlS4Cll•„. MO (i.t-i>4 ?.:ir. .4.»tOl',i«>. TX 78229 

r^x. (210) 57B-6»"T 

W*-Jr>)' 
03/0007 

10.4421 P. 2 PLANNING DEPT. 402-444-6140 


' ".'i'" ^ N' i ; ; 1 

TECHNOLOGIES, INC. 

TfXINiw^U* ^ •••—^•1 I 

Property Status Form 

ACdrcst /^/ ^ Cc^rh y ^-C , ^«te: ^^^^T^ ^ 

• IJ! *»•'» J- • Tm.#.T.'Jii -

Item NO Pfaots & Perutanent Landscaping To Remain In Place 

Go Map Description & Loe«t«on '". 

f { - fiauf^^e^ ^\~e£y 

I ;^o 6>f ; A'<^ ^ 

Pre-Eacjsttag Condition of Stryctures V 

»ocs your Baseniertt have a history of tealdng? Yes No 

Item NO Descripctoit <& Location 

OaMap 

Pradept Eniptoyee ^ 

01 
WmCJI.OlilF.S. INC. AS - BUILT DRAWING 

()I,S#:29693 

Date KM-axattd: lll/2S/20()9 OMAHA LEAD SUPERFUND SITE 

1>>KP.\ Signed Oi r Dote: 

29693 

Omah Exterior Paint North Arrow a Lead Site 

Sit • Good e Sketch 

D-Poor 

Sampling Addrsss: I6I8CORBY ST Q Not paint i 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm: 

Samples Collected 

RYASCPXA-29693 F l D Date: ^^7-^ \C n 

RYBSCPXA-29693 F2 

RYCSCPXA-29693 Bl 

RYDSCPXA-29893 B2 

RPZ8CPXA-g9093 BU 

noi:oorxA-E06oa o z 

-RPZOOPXA aoooa—P2> 

2S~ 7 pom 

2ia_PP'n 

jgi /f e ppm 

~ ppm 

' ­ ppm 

" " POT 

n 

D 

D 

D 

a 

D 

D 

D 

D 

Time: \Z'.3 ^ p>v\ 

Samples Analyzed 

XRF Unit: 6^^^ . Book: 19" ^ 

Date: IQ-ll'Q l 

Time: AiD 

Number of Samples = Lj .Qj Staff: MSW 

Legend: F1 = Front Left, F2 = Front Right, B1 = Bat* Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as vlawad from the atrect, fadng property 

ENTERjED 

OCT 0 22007 

• 9 

..?-.3p....[.3/(p 

U. 

-<i ^ .iji>ie...oxt&f..sy.. 

.25:1.. 

11 = 51 PPM a n r rJ^F.l n

wAi.tg': 

.C«6y.^. 

Itev5 l^ot i »il'2l»7ll 1S.13 

1-.V. = 2(1(1 I'PM « Sf ILVPK (-1") [_^^ ^^ _ ^ „.!r.'.*.,''l'I 

PRUDENTTECHNOLOGIES, INC. CONTRACT »: EP - R7-07-06 T0# 1 
29693 

Omah Exterior Paint North AIr^!^^• a Lead Site • Goori Site Sketch 

n^Poor 

Sampling Address: 1618 CORBY ST { J Not paint r 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Fim,: rp R ^ Pg> 

RYASCPXA-29693 F1 ppm D Date: q]?.^ \0 1 

RYBSCPXA-29693 F2 257 ppm D Time: ^2^'-3»0 pYW 

RYCSCPXA-29693 Bl 3^3 0 ppm D 

Samples Analyzed RYDSCPXA-29693 B2 ppm t a RDZOCPXA-2909S B? ppm XRF Unit: {o5HZ Book /^" ^ D ROgOOP)0^-2000a GZ ppm D Date: /a - I l ' 0 1 D •RPZOOPXA aoooo P2> ppm D 

D Time: A h 

a Staff; h$ W Number of Samples -

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

ENTERED 

OCT 0 2 2007 

ti ll r 

9 

Z30 3 (iff 

.61 U . 

HV \ .2sn 

F.i ^ ^ . 

OAhi ^^ 

Rev rreatol: 9-:4,^<i7 11 M n iw;i4i.(ii2 

http://\v\vvv.dhon.org,/ir1hinternci'DHONNoticeCreation/'MessageText.asp?ret=<RESULTS... 10/9/2009 

.v.. :-/.iiuiMiCTTTrtrOTTv.^iNnuucc;v.rcuiiuiy message iexi.asp.Ter=^Kti^ lU/V/ZUUV 

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Page 1 of2 

"> 

[ Create Anciher Ticket J | Back to irtli Internet J Send Email 

• YOUR TICKET NUMBER IS 238.3468. 

Origin.^.. Call Date: 10/0^-/09

Work t.O H.egir. Ddte: lO/l-i/09

 Tiic.e: 10:24 am 

Time: 11:00 am 

Op; SIVA18967 

State: Ul 

Address: 1618 

County: DOUGLAS 

Street: CORBY ST 

Place: OMAHA 

Twp: Ib^i Rng:

Twp: R-'ig: 

Legal Given: C 

13E Seci-.-Qtr: IC-SE-SW 

Secc-Qtr: 

Type of :\fork: SOIL LEAD REMEDIATION PROJECT 

Locati':?n of Work: LOCATE ENTIRE PROPERTY 

Remark:-: yAX ALL CLEARS "'O: { 402 • •• 3 j -1 b33 

: FAX .••\[.:L. CLEARS TO (402) 733 liS3 

: UNS'JRE CORNE.RS 

Comj)a.-iy : PRrjDF.MT TECHt^OLOGIE:S 

Conta.-.i". 1,'ame: SIVA .JAMPA.--;:\ Phone: (402)733-1188 

Work •Vj..i-,q Don.-^ For: EPA 

Depth •::•• E.xcavation: 6 FT C.-;rnor Lot: N 

Involve.'.-: Tuniisl.i.ng or Horizontal Boring : N 

Front: Y

Explosives: N 

CXCATV MAGELLAN MUDOl OMOLHACOF 0PPDGPR5 QLNNEIC 

Rear: 

Service .\rea Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS. INC HEIDI

Day: 4029340469 

Alt: 4029340469 

Einerg: 4029329757 

MAGEl.LAM MAGHLI.AN MIDSTREAM PARTNERS LP DEBORAH

Day:

 Alt: 

9185747098 

Emerg: 9185747098 

MUDOl ME I-KOi'OLrrAN UTILITIES DISTRICT SANDY

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

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Page 2 of2 

0PPDGPR5 OMAHA l»UBLIC TOWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://wi.vw.dhon.org/irthinternet/DHONNoticeC reationy'MessageText.asp?ret=<RESULTS... 10/9/2009 
TECHNOLOGiES, i^iC. 

Address: lQj.Sz-C<zy.. 

ere.: ff f ^— 

Date: JO /ro-n ^ 

^^y^Ac^yj/1^ ^ 

JC.: •• ^f.-^'v-^l ­

\ 

Overhead Lkiei? y^JL 

Gas Line 

\\ arer 1-hie 

SeNser I.ijie 

Septic / Leech 

field 

PrG|>a!ieRutane 

Sidewalk 

foundation 

Retaining \\ a lis 

Fences 

Trees Bushes .^_/ i 1^ ^ 

Structures 

Driveway 

" 1 

Sprinkier S>stem -y^^ ~ 

Other 

Crcn Foreman '"^ive S^j^.'ffn Officer* 

.y^^ ^